ASSISTIVE TECHNOLOGY DELIVERY SYSTEMS IN REHABILITATION - effectivity of delivery

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1 Pohjois-Pohjanmaan sairaanhoitopiiri ASSISTIVE TECHNOLOGY DELIVERY SYSTEMS IN REHABILITATION - effectivity of delivery Eero Kyllönen M.D., Ph.D. Clinic of Physical and Rehabilitation Medicine Oulu University Hospital European Union of Medical Specialists, section of PRM European Society of Physical and Rehabilitation Medicine

2 Pohjois-Pohjanmaan sairaanhoitopiiri New devices

3 Pohjois-Pohjanmaan sairaanhoitopiiri Controlling environment

4 Pohjois-Pohjanmaan sairaanhoitopiiri Independent life

5 POHJOIS-POHJANMAAN SAIRAANHOITOPIIRI CASE NORTHERN FINLAND: Oulu University Hospital Northern Ostrobotnia District Eero Kyllönen M.D., Ph.D. Clinic of Physical and Rehabilitation Medicine

6 Pohjois-Pohjanmaan sairaanhoitopiiri OULU UNIVERSITY HOSPITAL DISTRICT UTSJOKI Lappi Finland is devided in five University Hospital districts for special level treatments according to the agreements and state rules ENONTEKIÖ INARI Vaasa Pirkanmaa Satakunta Varsinais- Suomi Pohjois- Pohjanmaa Keski- Pohjanmaa Etelä- Pohjanmaa Länsi- Pohja Keski- Suomi HYKS OYS Pohjois- Savo KYS Etelä- Savo Kainuu Itä- Savo Pohjois- Karjala TAYS Päijät- Häme Etelä-Karjala Kanta- Häme Kymenlaakso TYKS Helsinki ja Uusimaa Hospital District 1. Lappi 2. Länsi-Pohja OUHD district has geographically largest area, 51,14% of Finland inhabitants , 14% of the total population in Finland OUH AND FOUR LOCAL HOSPITALS Population Percentage% , , ,9 3. P-Pohjanmaa 4. Kainuu ,8 5. K-Pohjanmaa ,2 All together ,0 Kemi Hospital MUONIO KOLARI PELLO YLITORNIO TORNIO 2 KEMI KITTILÄ TERVOLA KEMINMAA SIMO ROVANIEMI SODANKYLÄ RANUA SAVUKOSKI PELKOSENNIEMI KUUSAMO II TAIVALKOSKI YLI-II PUDASJÄRVI HAUKIPUDAS Oulu University Hospital KIIMINKI HAILUOTO OULU SUOMUSSALMI OULUNSALO KEMPELE MUHOS UTAJÄRVI PUOLANKA LUMIJOKI LIMINKA TYRNÄVÄ SIIKA- HYRYNSALMI RAAHE JOKI 3 RISTIJÄRVI PYHÄJOKI VAALA VIHANTI PALTAMO MERIJÄRVI 4 SIIKALATVA KALAJOKI OULAINEN KUHMO ALAVIESKA Kajaani HAAPAVESI VUOLIJOKI YLIVIESKA PYHÄNTÄ KANNUS NIVALA KÄRSÄMÄKI Hospital KAJAANI SOTKAMO KOKKOLA SIEVI TOHO- HAAPAJÄRVI KRUUNUPYY LAMPI 5 REISJÄRVI PYHÄJÄRVI KAUSTINEN LESTI- HALSUAJÄRVI VETELI PERHO Kokkola Hospital 1 KEMIJÄRVI POSIO SALLA RovaniemiHospital Pasi Parkkila 2010

7 Pohjois-Pohjanmaan sairaanhoitopiiri Challences Large 51,3% area, but only 13% of population Quite small population, sparcely inhabited In northern Finland distances are very long Logistic problems In winter time with a lot of snow And sometimes very cold but we are used to it

8 Pohjois-Pohjanmaan sairaanhoitopiiri Areal Rehabilitation AT Centre

9 Pohjois-Pohjanmaan sairaanhoitopiiri Oulu University Hospital

10 Population inhabitants Total OUH inh Hailuoto Haukipudas Kempele Kiiminki Muhos Oulu Oulunsalo Liminka Lumijoki Tyrnävä Yli-Ii

11 Who in responsible of the costs and delivery of assistive technology? - financing of AT consists of too many channels HEALTH CARE Health care centres - Moving and ADL basic AT Special Hospitals - expensive and demanding AT - hearing, vision ja communication, demanding AT - breath, demanding AT Schools - AT at scool for learning Social office in cities - According to the law for handicapped people AT changes at home Social Insurance Company - AT for severily handicapped in studying and working aged Insurance Companies - Traffic and other accidents - Also taken care in public hospitals State office - accidents at war and accidents and diseases at working places - for example war invalid AT Occupational health systems - AT for handicapped at work

12 How to control the costs and manage the effectiveness?

13

14

15 The main principles of our task Our task is to produce rehabilitation and equipment delivery for the special health care and health care of the local cities, on-line registry and to teach and make scientific studies for developing AT delivery systems. Quality, effectivity and cost effectiveness of the delivery we follow to maintain and increase the patients functioning and activities of daily living. We coordinate in the Oulu University Hospital district the rehabilitation AT delivery and participate national and international workshops

16 Special Health Care AT Services new referrals/year to areal AT Centre Electrical movement equipments: ewheelchair, moped AT Centre Environmental control - AT Centre demanding equipment for visual handicapped /Visual AT Centre Demanding equipment for breath AT Centre Electrical movement equipment for children and ADL AT Centre Evaluation of the first and special prosthesis for amputated person PRM, Childrens Hospital and AT Centre Testing and first use of new equipments: communicating national authorities and other AT Centres AT immediately combined with treatment and operation PRM AT Centre and special clinics Communication Centre Audiology AT Centre

17 Health Care Centres AT Movement and ADL basic equipmenrt Walking sticks, canes, rollators Manual wheelcairs, bikes Beds and matresses Toiletseats and elevations ADL AT Orthosis Small chances at home Basic AT for poor eyesight

18 Lenting Appointment

19 Evaluation, fitting, testing, release, use, follow-up, service

20 Evaluation of the need and selection of AT Multidisciplinary evalution - patient and relatives, - rehabilitation and nursing specialists - AT and tecnical specialists - Environmental changes - 30 workers 18 therapists Part-time PRM specialist 6 service workers 5 others

21 The Health Care Law and Statute of AT Delivery in Finland 1 principles for the delivery - Medically diagnosed/regocnised disease, trauma, handicap, which debilitates functioning and aggravates independent life. - To support, maintain or improve functioning in ADL 2 evaluation of the needs - Evaluation based on individual needs, user-specific, just-ontime - To regognize the function, life situation and environment Decisions with agreement of the patient 3 started

22 Rehabilitation principles for AT AT is only one part of the rehabilitation process and care Rehabilitation-, care- or health plan listed Total responsibility for care is in health care system: Health centres, hospitals, others Not in AT centre

23 Evaluation of the AT needs Personal functioning and extra help Motivation of the person Knowledge of the daily life and functioning Knowledge of the surroundings Knowledge of the AT:s, their possibilities and use

24 Recommendations must include Functioning of the patient Moving, vision, hearing, cognition Musculoskeletal abnormalities ADL and extra help AT aids used previously ADL and surroundings Family and living Work/pension/a.s.o. AT needs of surroundings: Possibilities and security

25 Recommendations must include Patients and surroundings Motivation for use of AT AT independent use or extra help Alcohol/drug abuse, if exists

26 Recommendations for the evaluation The guidelines criteria must be full Evaluation is done in Areal AT Centre before the delivery by PT:s and/or PRM specialist Usually only one same piece is delivered Two pieces need separate decision

27 Decision of rehabitation AT aids in AT Aids Centre PRM-doctors are responcible of the decisions AT-decision is medical decision for the patient Areal agreements and guidelines are in internet Individual AT delivery for the patients Physiotherapists can decide under 3000 AT:s according to the guidelines

28 Rehabilitation AT Aids Guidelines Hospitals and cities have an agreement of the work and responcibility The guidelines have been used since 2005 in Northern Ostrobotnia District Updated in 2009 ja 2011 and can be seen in Internet Common criteria for evaluation of the AT delivery are one part of the public guidelines of health care

29 Pohjois-Pohjanmaan sairaanhoitopiiri AT Delivery Principles in Oulu University Hospital District in Northern Finland Medical Rehabilitation unit AT Delivery Services Centre AT Delivery Principles

30 Pohjois-Pohjanmaan sairaanhoitopiiri THANK YOU!

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